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Laparoscopic versus open colorectal resections in patients with symptomatic stage IV colorectal cancer



The purpose of this study was to evaluate short-term and oncologic outcomes of laparoscopic resection (LR) for patients with symptomatic stage IV colorectal cancer compared with open resection (OR).


This study is a retrospective analysis of a prospective database. Patients with a minimum follow-up of 12 months after LR or OR for metastatic colorectal cancer were included. All analyses were performed on an “intention-to-treat” basis.


A total of 162 consecutive patients submitted to LR and 127 submitted to OR were included. In the LR group, conversion rate was 26.5 %, mostly due to locally advanced disease (88.4 %). A greater risk of conversion was observed among patients with a tumor size greater than 5 cm regardless the tumor site (P = 0.07). Early postoperative outcome was significantly better for LR group, with a shorter hospital stay (P = 0.008), earlier onset of adjuvant treatment, and similar postoperative complications (P = 0.853) and mortality rates (P = 0.958). LR for rectal cancer was associated with a higher morbidity compared with colon cancer (P = 0.058). During a median follow-up time of 72 months, there was no significant difference in overall survival between the two groups (P = 0.622).


LR for symptomatic metastatic CRC is safe and, compared with OR, is associated with a shorter hospital stay and with similar survival rates. Concerns remain about LR of bulky tumors and rectal cancers due to the increased risk of conversion and postoperative complications.

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Marco Ettore Allaix, Maurizio Degiuli, Giuseppe Giraudo, Alessandra Marano, and Mario Morino have no conflict of interest or financial ties to disclose.

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Correspondence to Mario Morino.

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Allaix, M.E., Degiuli, M., Giraudo, G. et al. Laparoscopic versus open colorectal resections in patients with symptomatic stage IV colorectal cancer. Surg Endosc 26, 2609–2616 (2012). https://doi.org/10.1007/s00464-012-2240-5

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  • Symptomatic
  • Metastatic
  • Colorectal cancer
  • Laparoscopy